手指皮肤脱套再植的临床疗效分析  

Analysis of the curative effect of replantation of severed limbs after detachment

作　　者：陈延岭 魏明杰 王腾 徐永清[1] Chen Yanling;Wei Mingjie;Wang Teng;Xu Yongqing(Department of Orthopaedics,920 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Kunming 650032,China;Postgraduate Department of Kunming Medical University,Kunming 650000,China)

机构地区：[1]中国人民解放军联勤保障部队第九二O医院骨科,昆明650032 [2]昆明医科大学研究生院,昆明650000

出　　处：《创伤外科杂志》2021年第6期417-419,共3页Journal of Traumatic Surgery

基　　金：云南省创伤骨科临床医学中心(ZX20191001)。

摘　　要：目的探讨手指皮肤脱套再植的临床效果。方法回顾性分析2014年1月—2019年10月解放军联勤保障部队第九二O医院骨科对11例(11指)手指皮肤脱套伤患者行再植术的治疗效果,男性7例,女性4例;年龄24~45岁,平均33.6岁。均为机器绞伤,单指脱套伤。右手7例,左手4例;其中拇指1例,食指5例,中指4例,环指1例。脱套指体远端、近端指骨均相对完整,伴骨折或指间关节脱位,屈伸肌腱部分损伤,连续性存在。患者均急诊行清创和再植术,伤后至手术时间3~11h,平均7.3h。随访时间6~13个月,平均9.0个月,观察再植术后存活率及功能恢复情况。结果11例手指脱套再植全部存活,其中2例术后出现静脉回流障碍,1例动脉供血障碍,经使用解痉药物及手术探查取栓重新吻合血管后存活。手指末端指腹两点辨别感觉5~9mm,按中华医学会手外科学会断指再植功能评定试用标准,优7指,良3指,可1指,优良率91%。结论对远端指体完整、挫伤相对较轻的手指脱套患者行再植手术临床疗效满意。Objective To investigate the clinical effect of replantation of finger skin avulsion injury.Methods A retrospective analysis of the effect of replantation on 11 patients(11 fingers)with finger skin avulsion injury in the Department of Orthopaedics,920 Hospital of Joint Logistics Support Force of the People’s Liberation Army from Jan.2014 to Oct.2019 was carried out,including 7 males and 4 females,aged 24 to 45 years,with an average of 33.6 years.All were machine-struck injuries and single-finger avulsion injuries.There were 7 cases of right hand and 4 cases of left hand;among them,there was 1 case of thumb injury,5 cases of index finger injury,4 cases of middle finger injury,and 1 case of the ring finger injury.The distal and proximal phalanges of the detached finger were relatively intact,with fractures or dislocation of the interphalangeal joints,and partial injury of the flexor and extensor tendons,which were continuous.All patients underwent emergency debridement and replantation.The time from injury to operation was 3-11 hours,with an average of 7.3 hours.The postoperative follow-up was 6 to 13(9.0 on average)months to observe the survival rate and functional recovery after replantation.Results All 11 cases of finger avulsion injury after replantation survived,of which 2 cases had venous reflux disorder after operation,and 1 case had arterial blood supply disorder,and survived after using antispasmodic drugs and surgical exploration to remove the thrombus and reattach the blood vessels.The two-point discriminative sensation of the fingertips at the end of the finger was 5-9mm.According to the evaluation standard of the Chinese Medical Association Hand Surgery Society,the function of the severed finger replantation was excellent in 7 fingers,good in 3 fingers,and fair in 1 finger,with an excellent and good rate of 91%.Conclusion The clinical effect of replantation is satisfactory for patients with complete distal finger body and relatively mild contusion.

关 键 词：软组织损伤 手指脱套伤 清创 断指再植 

分 类 号：R658.1[医药卫生—外科学]